(hallux valgus; hallux abducto valgus)
|Information for health professionals
a bunion (hallux valgus; hallux abducto valgus)?
A bunion is generally
considered as an enlargement of the joint (a lump of bone) at
the base and side of the big toe - (specifically, the first metatarsophalangeal
joint). Bunions form when the toe moves out of place. As the big
toe bends towards the others this lump becomes larger and the
bunion can become painful - arthritis and stiffness can eventually
develop. Hallux valgus or hallux abducto valgus (HAV) is the name
used for the deviated position of the big toe and a bunion refers
to the enlargement of the joint - most of the time the two go
together and can just be referred to as 'bunions'.
The word bunion is
from the Latin "bunion," meaning enlargement.
bunions look like?
the symptoms of bunions
Bunions starts as the big toe begins
to deviate, developing a firm bump on the inside edge of the foot,
at the base of the big toe. Initially, at this stage the bunion
may not be painful. Later as the toes deviate more the bunion can
become painful - there may be redness, some swelling, or pain at
or near the joint. The pain is most commonly due to two things -
it can be from the pressure of the footwear on the bunion or it
can be due to an arthritis like pain from the pressure inside the
joint. The motion of the joint may be restricted or painful. A hammer
toe of the second toe is common with bunions. Corns and calluses
can develop on the bunion, the big toe and the second toe due to
the alterations in pressure from the footwear. The pressure from
the great toe on the other toes can also cause corns to develop
on the outside of the little toe or between the toes. The change
in pressure on the toe may predispose to an ingrown
footwear that is too tight or causing the toes to be squeezed together
are the most commonly blamed factor for the cause of bunions and
hallux valgus and is undoubtedly the main contributing factor. This
probably is the reason for the higher prevalence of bunions among
women. However, studies of some indigenous populations that never
wear footwear, show that they also get bunions - BUT, they are very
uncommon. As they do get bunions, factors other than footwear must
play a role in the cause, even though footwear is the main culprit
for providing the pressure that causes the symptoms.
are most widely considered to be due to an imbalance in the forces
that is exerted across the joint during walking. The resulting abnormal
motion and pressure over the joint, over many years (combined with
poor fitting footwear) leads to instability in the joint causing
hallux valgus and bunions. Bunions are really only a symptom of
faulty foot mechanics and are usually caused by a combination of
the way we walk, the foot we inherit and inappropriate footwear
Bunions are not inherited, but do tend to run in families. What
is inherited is the poor or faulty foot type, that mechanically
can lead to the instability around the joint that will eventually
lead to bunions - how soon, how quickly and how bad they are or
become is assumed to be very dependant on the footwear.
of other factors are known to play a role in the cause of bunions
and hallux valgus. Bunions can follow foot injuries and develop
in those with neuromuscular problems. Those with flat
feet or pronated feet appear
to be more prone to the instability about the joint and have a higher
incidence of bunions. Some activities (eg ballet dancing) puts added
pressure on the joint and may increase the chance of bunions developing.
are many treatment options for bunions and they will vary with the
type and severity of each bunion and will also depend on what is
causing the symptoms. Bunions are almost always progressive and
tend to get larger and more painful with time - how fast this happens
may be a function of the fit of the footwear.
goal of treatment options is to relieve pressure on the bunion and
any symptoms that may be present and to halt or slow the progression
of the joint deformity. There is no effective may be "get rid
off" a bunion without surgery.
There are a number of things that individuals (see below)
and Podiatrists can do to help the symptoms and slow (if not halt)
Some conservative approaches
used to manage bunions and hallux valgus include:
with a number of different materials (eg felt) to reduce pressure
on the painful prominence of the bunion.
therapy can be used to help with the symptoms and improve the range
of motion (this is particularly helpful if the pain is coming from
inside the joint, rather than from shoe pressure). Manipulation
of the joint can be used to help with this (manipulation will NEVER
correct the alignment of the joint).
* Any corns and calluses that are
causing symptoms should be treated.
advice - the correct fitting of footwear
is essential for anyone who is serious about doing something about
their bunions and hallux valgus - follow
It may be possible to have your shoes stretched over the area of
the bunion to also relieve pressure.
orthotics may be useful in helping with the instability about
the joint. They may be more helpful if there are other symptoms
in the foot as well, as their use in "treating" bunions
is controversial. They may play a role in slowing progression and
in the prevention of bunions developing again after surgical correction.
(see below) can be important in maintaining the mobility
of the joint in those with bunions - this is especially important
for the arthritic type pains that may be originating from inside
the joint and for the prevention of these painful symptoms in the
and exercises for bunions
you do yourself for bunions:
1. Follow the advice given
by a Podiatrist
2. Use felt pads to help
keep pressure off the painful area of the bunions.
3. Wear shoes that are
wide and deep to accomodate the bunions. Fitting
of footwear is very important. Avoid the use of high heel shoes.
4. Use exercises (see
below) to keep the joint mobile
5. Night splints may help
with the bunion symptoms (see below). The aim of these
are to hold the toe in a more correct position.
or foam between the big toe and the second toe is sometimes recommended
- it should, generally, not be recommended as the big toe is usually
so strong it just further 'squeezes' the lesser toes and can lead
to problems between these toes. The padding between the two toes
will not straighten the big toe. However, sometimes the padding
may be needed to help with symptoms that originate inside the joint
if the bunion is painful.
the joint mobile is important as this goes a long way to helping
and prevent the arthritic type pain that can develop inside the
joint of those with bunions. Several exercises are recommended:
1. Grasp the big toe with one hand and do some
'yoga' like stretches on the joint in all directions. Hold the position
at the end range of motion for 10-15 seconds. Repeat several times
in all directions.
2. Traction helps some people with spinal problems,
and can also help keep the big toe joint mobile. Grasp the toe and
the foot and try and "pull" the toe "off". Hold
for 10-15 seconds. Repeat several times.
|3. Find some sort of elastic band and loop it around both big toes.
Spread your feet so that the toe is "straightened" - hold
for several minutes. Repeat several times.
Exercises will NEVER be able to
correct the position of the toe due to the adaption of bone that
has gone on for many years as the bunion developed, but they are
important to keep the toe flexible and mobile.
for a bunion
Wearing splints at night have been
shown to provide some correction in adolescents with hallux valgus
or bunions (where they are young enough for the bone to still adapt).
Read about this evidence here
They may not be as effective in adults, but could be useful to help
keep the joint mobile. As a bunion (hallux valgus) is a bony abnormality,
it is much harder to change position of a toe permanently in adults.
As footwear plays such
an important role in the development and symptoms of bunions,
proper fit is vitally important. It is poor fitting footwear in
combination with the other factors mentioned above that is the
cause of bunions. Footwear also provides the force that makes
them painful - the use of the correct
footwear is YOUR responsibility.
the bunion symptoms does not respond to the conservative measures
or if the bunion has progressed past a threshold where these measures
are not effective, bunion surgery
may be necessary to correct alignment and remove the bunion. A large
range of types of surgical procedures for bunions are available
and the choice will depend on things like what bone or bones are
involved, the angular relationship between the different bones,
the amount of damage to the joint and the presence of deformities
other than the bunion.
relevance to bunions (hallux valgus; hallux abducto valgus)
resources on hallux valgus or hallux abducto valgus
a question in the foot health forum about bunions
books on foot care:
Little Foot Care Book
Foot Care Tips for those with Diabetes
Foot Book - Relief for Overused, Abused and Ailing feet
Foot Care: Herbal Blends and Soothing Treatments to Pamper Your
|External: Bunions @ the Foot Health Forum
products to help your bunions (hallux valgus; hallux abducto valgus)
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|Australia & NZ:
is purely a source of information on the bunion (hallux valgus;
hallux abducto valgus) and should at no time be considered as replacing
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advice for bunions (hallux valgus; hallux abducto valgus) and all
foot problems before embarking on any form of self treatment or
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valgus; hallux abducto valgus) or any other problem because of something
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valgus; hallux abducto valgus) is subject to copyright. No part
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(hallux valgus; hallux abductovalgus)